Nurse endoscopists perform colonoscopies according to the international standard and with high patient satisfaction

Background and study aims: Colonoscopy is increasingly performed by nurse endoscopists. We aimed to assess the endoscopic quality and patient experience of these procedures.

Patients and methods: This prospective multicenter study analyzed 100 consecutive colonoscopies each for 10 trained nurse endoscopists with respect to endoscopic quality and patient experience. Colonoscopies were performed under the supervision of a gastroenterologist, using the techniques and protocols of the participating hospitals. Patient experience was assessed using a questionnaire.

Results: Most nurse endoscopists were female (90 %; median age 43 [range 35 – 49]). Before the start of the study, they had performed a median of 528 colonoscopies (range 208 – 2103). For the 1000 patients, mean age was 56 ± 15 years; 55 % were women; and 96 % were in class I or II according to the American Society of Anesthesiologists’ physical status classification system. Colonoscopies were performed for screening or surveillance in 42 %; for symptomatic indications in 58 % of patients. The unassisted cecal intubation rate was 94 %; the mean withdrawal time was 10 ± 5 minutes. The adenoma detection rate was 26.7 %. In 229 of the colonoscopies (23 %), the nurse endoscopists required assistance from the supervising gastroenterologist. The complication rate was 0.2 %: one perforation and one cardiopulmonary complication. The questionnaire was completed by 734 /1000 patients (73 %) and of these 694 /734 (95 %) were satisfied with the endoscopic procedure. Among the respondents 530 /734 (72 %) had no specific preference for a physician or nurse endoscopist, whereas 113 /734 (15 %) preferred a physician endoscopist, and 91 /734 (12 %) preferred a nurse endoscopist.

Conclusion: The nurse endoscopists performed colonoscopies according to the internationally recognized quality standards and with high patient satisfaction.

• References

• 1 Ferlay J, Autier P, Boniol M et al. Estimates of the cancer incidence and mortality in Europe in 2006. Ann Oncol 2007; 18: 581-592
• 2 Jemal A, Siegel R, Ward E et al. Cancer statistics 2007. CA Cancer J Clin 2007; 57: 43-66
• 3 Levin B, Lieberman DA, McFarland B et al. Screening and surveillance for the early detection of colorectal cancer and adenomatous polyps 2008: a joint guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology. CA Cancer J Clin 2008; 58: 130-160
• 4 Mandel JS, Church TR, Bond JH et al. The effect of fecal occult-blood screening on the incidence of colorectal cancer. N Engl J Med 2000; 343: 1603-1607
• 5 Atkin WS, Edwards R, Kralj-Hans I et al. Once-only flexible sigmoidoscopy screening in prevention of colorectal cancer: a multicentre randomised controlled trial. Lancet 2010; 375: 1624-1633
• 6 Benson VS, Patnick J, Davies AK et al. Colorectal cancer screening: a comparison of 35 initiatives in 17 countries. Int J Cancer 2008; 122: 1357-1367
• 7 Butterly L, Olenec C, Goodrich M et al. Colonoscopy demand and capacity in New Hampshire. Am J Prev Med 2007; 32: 25-31
• 8 Vijan S, Inadomi J, Hayward RA et al. Projections of demand and capacity for colonoscopy related to increasing rates of colorectal cancer screening in the United States. Aliment Pharmacol Ther 2004; 20: 507-515
• 9 Brown ML, Klabunde CN, Mysliwiec P. Current capacity for endoscopic colorectal cancer screening in the United States: data from the National Cancer Institute survey of colorectal cancer screening practices. Am J Med 2003; 115: 129-133
• 10 Tappenden P, Chilcott J, Eggington S et al. Option appraisal of population-based colorectal cancer screening programmes in England. Gut 2007; 56: 677-684
• 11 Weller D, Coleman D, Robertson R et al. The UK colorectal cancer screening pilot: results of the second round of screening in England. Br J Cancer 2007; 97: 1601-1605
• 12 Seeff LC, Manninen DL, Dong FB et al. Is there endoscopic capacity to provide colorectal cancer screening to the unscreened population in the United States?. Gastroenterol 2004; 127: 1661-1669
• 13 Lau A, Gregor JC. Resource implications for a population-based colorectal cancer screening program in Canada: a study of the impact on colonoscopy capacity and costs in London, Ontario. Can J Gastroenterol 2007; 21: 371-377
• 14 Verschuur EM, Kuipers EJ, Siersema PD. Nurses working in GI and endoscopic practice: a review. Gastrointest Endosc 2007; 65: 469-479
• 15 Williams J, Russell I, Durai D et al. What are the clinical outcome and cost-effectiveness of endoscopy undertaken by nurses when compared with doctors? A Multi-Institution Nurse Endoscopy Trial (MINuET).. Health Technol Assess 2006; iii, iv, ix-x 10: 1-195
• 16 Koornstra JJ, Corporaal S, Giezen-Beintema WM et al. Colonoscopy training for nurse endoscopists: a feasibility study. Gastrointest Endosc 2009; 69: 688-695
• 17 Maslekar S, Hughes M, Gardiner A et al. Patient satisfaction with lower gastrointestinal endoscopy: doctors, nurse and nonmedical endoscopists. Colorectal Dis 2010; 12: 1033-1038
• 18 Limoges-Gonzalez M, Mann NS, Al-Juburi A et al. Comparisons of screening colonoscopy performed by a nurse practitioner and gastroenterologists: a single-center randomized controlled trial. Gastroenterol Nurs 2011; 34: 210-216
• 19 Barclay RL, Vicari JJ, Doughty AS et al. Colonoscopic withdrawal times and adenoma detection during screening colonoscopy. N Engl J Med 2006; 355: 2533-2541
• 20 Shum NF, Lui YL, Choi HK et al. A comprehensive training programme for nurse endoscopist performing flexible sigmoidoscopy in Hong Kong. J Clin Nurs 19: 1891-1896
• 21 Non-Medical Endoscopists. In: A Report of the Working Party of the British Society of Gastroenterol. 2005 Available from: http://www.bsg.org.uk
• 22 Douglass A, Barrison I, Powell A, Bramble M. The nurse endoscopist’s contribution to service delivery. Gastrointest Nurs 2004; 2: 21-24
• 23 Pathmakanthan S, Murray I, Smith K et al. Nurse endoscopists in United Kingdom health care: a survey of prevalence, skills and attitudes. J Adv Nurs 2001; 36: 705-710
• 24 American Society for Gastrointestinal Endoscopy. Endoscopy by non-physicians: guidelines for clinical application. From the ASGE. Gastrointest Endosc 1999; 49: 826-828
• 25 Seeff LC, Richards TB, Shapiro JA et al. How many endoscopies are performed for colorectal cancer screening? Results from CDC’s survey of endoscopic capacity.. Gastroenterol 2004; 127: 1670-1677
• 26 Balaguer F, Llach J, Castells A et al. The European panel on the appropriateness of gastrointestinal endoscopy guidelines colonoscopy in an open-access endoscopy unit: a prospective study. Aliment Pharmacol Ther 2005; 21: 609-613
• 27 Froehlich F, Repond C, Mullhaupt B et al. Is the diagnostic yield of upper GI endoscopy improved by the use of explicit panel-based appropriateness criteria?. Gastrointest Endosc 2000; 52: 333-341
• 28 Mysliwiec PA, Brown ML, Klabunde CN, Ransohoff DF. Are physicians doing too much colonoscopy? A national survey of colorectal surveillance after polypectomy.. Ann Intern Med 2004; 141: 264-271
• 29 Rex DK, Lieberman DA. Feasibility of colonoscopy screening: discussion of issues and recommendations regarding implementation. Gastrointest Endosc 2001; 54: 662-667
• 30 Joint Advisory Group on Gastrointestinal Endoscopy. Guidelines on the training, appraisal and assessment of trainees in GI endoscopy. London: JAG; 2004
• 31 de Jonge V, Sint Nicolaas J, Cahen DL et al. Quality evaluation of colonoscopy reporting and colonoscopy performance in daily clinical practice. Gastrointest Endosc 2012; 75: 98-106